大脑微梗死与颈动脉狭窄的相关性及对预后的影响

Correlation Analysis of Cerebral Micro-Infarction with Carotid Artery Stenosis and Its Impact on Prognosis in Patients with Acute Mild Ischemic

目的:探讨急性轻型前循环缺血性脑卒中患者颈动脉狭窄(CS)与3.0T磁共振成像显示的大脑微梗死(CMI)相关性。方法:连续纳入发病7d内美国国立卫生研究院卒中量表评分≤3分的急性轻型前循环缺血性脑卒中住院患者,以有无CMI病变分为无CMI组和CMI组,比较2组间基线资料、影像特点、神经功能及预后。结果:无CMI组与CMI组在糖尿病、心房颤动发生率方面有显著性差异(均P<0.05)。2组在CS程度上有差异(=13.744,P=0.003);Spearman相关分析显示CMI组CMI数量与CS程度呈正相关(r=0.520,P<0.001)。多因素logistic回归结果显示糖尿病、心房颤动、卒中病史、腔隙存在、颈动脉重度狭窄或闭塞均与CMI病变独立相关(均P<0.05)。CMI病变组90d不良预后比例显著高于无CMI病变组(13.64%比28.30%,X=11.844,P=0.019)。结论:糖尿病、心房颤动、卒中病史、腔隙存在以及颈动脉重度狭窄或闭塞是CMI病变的独立危险因素,CMI病变与90d不良预后有关。

Purpose:To explore the correlation between carotid artery stenosis(CS)and cerebral micro-infarction(CMI)on 3.0 T magnetic resonance imaging in patients with acute mild ischemic stroke of the anterior circulation.Methods:The subjects of the study were inpatients with acute mild ischemic stroke of the anterior circulation with a stroke score of<3 points on the National Institutes of Health Stroke Scale within 7 consecutive days of onset.The enrolled patients were divided into the non-CMI group and CMI group based on the presence of CMI or not.Further comparative analysis was made on baseline data,imaging characteristics,neurological function,and prognosis between the two groups.Results:There were significant differences in incidences of diabetes and atrial fibrillation between the non-CMI group and the CMI group(all P<0.05).A difference in the degree of CS was found between the two groups(X^(2)=13.744,P=0.003).Spearman's correlation analysis showed a positive correlation between the number of CMI and the degree of CS in the CMI group(r=0.520,P<0.001).According to the results of multivariate logistic regression analysis,diabetes,atrial fibrillation,stroke history,the presence of lacunae,and severe CS or occlusion were all independently associated with CMI(all P<0.05).In addition,the proportion of poor 90-day prognosis in the CMI group was significantly higher than that in the non-CMI group(13.64%vs 28.30%,X^(2)=11.844,P=0.019).Conclusion:This study suggests that diabetes,atrial fibrillation,stroke history,the presence of lacunae,and severe CS or occlusion are independent risk factors for CMI,and CMI is associated with a poor 90-day prognosis.